key: cord-0753420-rnqlau86
authors: Zic, J. A.; Ai, W.; Akilov, O. E.; Carter, J. B.; Duvic, M.; Foss, F.; Girardi, M.; Gru, A. A.; Kim, E.; Musiek, A.; Olsen, E. A.; Schieke, S. M.; Shinohara, M.; Zain, J. M.; Geskin, L. J.
title: United States Cutaneous Lymphoma Consortium Recommendations for Treatment of Cutaneous Lymphomas During the COVID-19 Pandemic
date: 2020-04-16
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.04.049
sha: f090a77510fd476057ee5d2636207e80a7f95a5c
doc_id: 753420
cord_uid: rnqlau86

nan

A. Low risk: topical retinoids, mechlorethamine gel or ointment, topical steroids with or without occlusion, imiquimod, home narrowband UVB phototherapy (NBUVB), heliotherapy, oral antibiotics, oral antipruritics, dilute vinegar or bleach soaks/baths, and aggressive moisturization.

B. Intermediate risk: oral retinoids (bexarotene, acitretin, isotretinoin), methotrexate, oral steroids, vorinostat, and interferons (alpha or gamma).

C. High risk: pralatrexate, romidepsin, mogamulizumab, brentuximab, gemcitabine and other chemotherapies. Skin radiotherapy, photopheresis and office-based UV therapy are high risk due to travel.

Low-risk therapies that can be utilized at home should be continued for all patients. The risks of travel and exposure likely outweigh the benefit of in-office treatments such as ultraviolet light therapy and total body electron beam radiation therapy. Home-based NBUVB and heliotherapy can be continued or initiated.

For patients with low-risk disease only low-risk therapies are recommended.

Intermediate-risk therapies may be continued, but dose adjustments may be advised on an individual basis. The least frequent lab monitoring possible should be performed to limit exposure while ensuring patient safety. Initiation of these therapies may be postponed using low-risk bridge therapies short term.

Increasing or initiation of a retinoid or interferon should be considered in cases that necessitate the removal of other high-risk therapies.

High-risk therapies, in addition to their inherent risks, may require travel to the clinic or hospital.

These should only be utilized in the highest risk patients and the additional risks of therapy-related travel should be considered. Infusion regimens may be adjusted to increase treatment intervals. Romidepsin and mogamulizumab may be considered on individual basis with extended intervals and lower doses.

Allogeneic stem cell transplant and treatment with CHOP, alemtuzumab, fludarabine are strongly discouraged during the pandemic because they often lead to significant cytopenias that are known risk factors for COVID-19 complications. 3, 4 Consider alternative lower risk therapies whenever possible.

Characteristics of and important lessons from the Coronavirus Disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention

Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China

Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis

Comorbidities and multi-organ injuries in the treatment of COVID-19